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Ethics of Clinical Decision-Making for Older Drivers: Reporting Health-Related Driving Risk

Published online by Cambridge University Press:  27 April 2016

Barbara Mazer ,
Maude Laliberté ,
Matthew Hunt ,
Josée Lemoignan ,
Isabelle Gélinas ,
Brenda Vrkljan ,
Gary Naglie  and
Shawn Marshall
Barbara Mazer*
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Maude Laliberté
Affiliation:
Faculté de médecine, École de réadaptation, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
Matthew Hunt
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Josée Lemoignan
Affiliation:
Faculté de médecine, École de réadaptation, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
Isabelle Gélinas
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Brenda Vrkljan
Affiliation:
School of Rehabilitation Science, McMaster University
Gary Naglie
Affiliation:
Department of Medicine and Rotman Research Institute, Baycrest Health Sciences; Research Department, Toronto Rehabilitation Institute, University Health Network Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto
Shawn Marshall
Affiliation:
Ottawa Hospital Research Institute, University of Ottawa
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Barbara Mazer, Ph.D. CRIR-Jewish Rehabilitation Hospital 3205 Place Alton Goldbloom Laval, QC H7V 1R2 ([email protected])
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Abstract

The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens.

Résumé

Le vieillissement de la population engendre une augmentation du nombre de conducteurs âgés. Les professionnels de la santé ont la responsabilité de fournir des soins en préservant le secret professionnel tout en assurant la sécurité du public. Cet article traite de l’analyse éthique relative à la prise de décisions en lien avec le signalement aux autorités compétentes des conducteurs âgés identifiés comme étant à risque. Des considérations éthiques inhérentes au signalement des conducteurs à risque sont traitées, telles que l’autonomie, le secret professionnel, la relation thérapeutique et l’incertitude associée à l’évaluation de la conduite automobile. Nous abordons également la question de la responsabilité des divers agents moraux. L’incertitude entourant le raisonnement clinique et les concepts liés à l’évaluation du risque sont également traités. Enfin, nous présentons deux cas illustrant certains défis auxquels sont confrontés les professionnels de la santé dans l’atteinte d’un équilibre entre leurs responsabilités face à leurs patients et celles visant à assurer la sécurité du public.

Keywords

vieillissementconduite automobileévaluationéthique cliniqueagingdrivingassessmentclinical ethics
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 35 , Special Issue S1: Older Driver Research: Evidence to Guide Change / Recherche sur la conduite automobile des personnes âgées : des preuves afin de guider le changement , June 2016 , pp. 69 - 80
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Copyright
Copyright © Canadian Association on Gerontology 2016 

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